Healthcare Provider Details

I. General information

NPI: 1609137504
Provider Name (Legal Business Name): NATHAN ANDREW WIGNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 301
LAS CRUCES NM
88011-8262
US

IV. Provider business mailing address

4030 SOMMERSET ARC
LAS CRUCES NM
88011-1717
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-9755
  • Fax: 575-532-8881
Mailing address:
  • Phone: 206-819-5461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberV3732
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberMD60738147
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberMD2022-1319
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD2022-1319
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: